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What is a High-Value Health Insurance Plan? - Benefits

Team AckoNov 10, 2021

Not long ago, Rs. 5 lakhs or even Rs. 10 lakhs health insurance coverage seemed perfectly adequate. However, with advancements in medical facilities, the cost of healthcare has increased multifold. The health insurance industry is responding to the steep rise in healthcare expenses by offering high-value health insurance policies.

What is a High-Value Health Insurance Plan?

High-value medical insurance plans are more exhaustive and holistic with enough coverage to match skyrocketing healthcare costs and covering critical illness and new-age treatments. In this article, you will learn about the need for high-value health insurance policies and their unique benefits.

What is high-value health insurance in India?

A high-value health insurance plan is designed to cover expensive healthcare treatments. Typically, the sum insured for these policies is higher and can go up to Rs. 1 crore or more. What differentiates high-value medical insurance from regular health insurance is the sum insured amount. 

Along with the higher coverage for hospitalisation, it also provides coverage for critical illnesses, pre and post-hospitalisation, Outpatient Department (OPD) expenses, organ transplant, advanced-stage cancer, day-care procedure, and other non-hospitalisation coverages.

Benefits and features of high-value medical insurance

Here are the benefits and features of high-value health insurance.

  • Offers comprehensive coverage: It provides coverage for maternity, critical illnesses, organ transplant, advanced-stage cancer, health checkups, OPD expenses, etc., making it an exhaustive health insurance plan.

  • Treatments in foreign countries: Provides coverage for medical expenses for treatments in international countries. Compared to medical costs in India, treatment in foreign countries can be more expensive.

  • No sub-limits in room rent: The plan does not have sub-limits on hospital room rents. However, it is subject to the terms of your health insurance plan, hospitalisation criteria and may apply to low category rooms.

Disadvantages of high-value health insurance

While high-value medical insurance has its advantages, it also has its drawbacks. Let’s take a look at them.

  • Higher premium: Naturally, a higher sum insured health insurance warrants a higher premium than regular plans. Since they are expensive, people belonging to low-income groups may not prefer to buy a high-value health plan.

  • Strict underwriting process: The underwriting process for high-value medical insurance plans is more rigorous compared to regular health insurance plans.

  • Higher co-pay for senior citizens: While the regular senior citizen health insurance plans do include co-pay, the high-value health insurance might require senior citizens to bear co-pay of more than 10% to 15%, increasing their out-of-pocket costs.

Who should opt for high-value health insurance?

Opting for a high-value health insurance plan is clearly dependent on your net worth, health insurance needs and future earnings. But the fact remains that health insurance is essential, and if you can afford the high premium, you should opt for the same. Also, if you prophesise the need for medical treatments in a foreign country, you should consider high-value health insurance.

Unless you are a high net-worth individual (HNI), access to high-value health insurance can be challenging due to the higher premium it warrants. However, if you are not an HNI, you can opt for the top-up or super top-up plans to extend the coverage of the basic plan.

How much health insurance do you need?

When you are shopping for a suitable health insurance plan, you may come across plans offering different types of sum insured amounts. But, how much medical insurance is enough? It is recommended that you factor in the below points before finalising the perfect health insurance plan for you or your family.

  • Capability to pay the premium: Not all can afford an Rs. 1 crore health insurance plan. Hence, assess your ability to pay the premium before settling on the right plan since the premium is directly proportional to the sum insured. Typically, you need to buy a health insurance plan with a sum insured amount of 50% to 100% of your annual income.

  • Family medical history: If any of your family members suffer from chronic or lifestyle diseases or has a history of hereditary disease, you should opt for health insurance with broader coverage and buy the plan as early as possible.

  • Age: One of the most significant factors while calculating the amount of coverage is the person’s age. When you are at the age of 25, there is very little chance of falling ill. You could also face unexpected injuries due to accidents that may require hospitalisation. Hence, a health insurance plan with a lower sum insured amount of Rs. 3 lakhs to Rs. 4 lakhs may suffice. However, if you are a middle-aged person, the probability of falling ill increases; hence, you need to opt for broader coverage.

  • Access to super-speciality hospitals: The cost of medical care differs between hospitals based on the facilities they provide. For a similar medical treatment, the cost can vary between hospitals. Based on your need for a specific hospital, you should buy a health insurance plan that offers coverage at speciality hospitals.

Frequently asked questions

Here are some of the common questions about high-value health insurance plans.

Is investment in health insurance worth it?

The benefits of medical insurance in India are not just significant but essential for everyone. Health insurance helps you avail of good medical care without having to pay from your pocket apart from the deductibles. Health insurance is vital during unforeseen medical emergencies. With high medical costs, it is wise to get health insurance coverage at an early stage of your life to protect yourself and your family against high healthcare costs and access good medical facilities.

Is health insurance expensive in India?

Healthcare costs have certainly increased over the years. The rise in costs is attributed to the advancements in technology and improved facilities in medical care. While the prices have risen, there have been disruptions by the industry especially among the digital-first health insurance companies such as ACKO. Online health insurance providers such as ACKO provide health insurance directly to customers, enabling them to offer an affordable health insurance plan.

Can I avail myself of cashless hospitalisation through a high-value health insurance plan?

Yes, you can avail of cashless hospitalisation through the high-value medical insurance plan just like regular health insurance plans that offer this facility.

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